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General NPI Number Information
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NPI Number | 1013971126
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA PATHOLOGY PC
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 3600 JOSEPH SIEWICK DR
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City | FAIRFAX
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State | VA
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Zip | 22033-1709
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Country | US
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Telephone | 703-391-3654
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Fax | 703-391-3049
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Provider Business Mailing Address
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Address Line | PO BOX 100559
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City | FLORENCE
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State | SC
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Zip | 29501-0559
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Country | US
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Telephone | 843-646-4300
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Fax | 843-646-4308
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE ANTHONY WERNESS
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Credential | M.D.
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Telephone | 703-391-3654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | MD0101042785
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0101049095
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License Number State | VA
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